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SEQUOIA ANALYTICAL SAMPLE RECEIPT <br /> CL1EN'T NAME: DATE Received at Lab: (Drinking water) for <br /> RE C. ]3X (PRINT) TIME Received at Lab: regulatory purposes: YES/IVO E <br /> k IaVORKORDER: LOG IN DATE; (Wastewater) for x <br /> regulatory purposes: YESINU <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DATE <br /> SAMPLE! # CLIENT ID DESCRIPTION MATRIX SA41PPED CONDITION (ETC.) } <br /> I. Custody Seal(s) Present AbsentNAN <br /> _ ___ _ Intact/Brol en* <br /> J Ay <br /> fi.�2._ChAin-of-Custody y eselrt bsettt* �� U <br /> 3, Tralltc Reports or V <br /> f Packing List: Present/ sent <br /> 4. Airbill; A.i.rbill 1 Sticker <br /> Present Se <br /> 5. Ainbiil #:�� <br /> _6, Sample Labels: reser Absent <br /> 7. Sample IDs: of Listed <br /> _ <br /> on Clzaln-of Custod <br /> 8. Sample Collditiolu n Broken*/ <br /> _ _ Lcalcizz <br /> <; y. Does informadoa on <br /> custody reports, traffic, <br /> reports and sample <br /> _ labels agree? yt INo* <br /> 1D. Sample received within <br /> _ bold titre: No* <br /> 11. Proper Preservatives <br /> t <br /> used: Ye /No* <br /> 12. Ti enlp Rec. at Lab: <br /> (Acceptance range for samples <br /> re uirin t.Eternxal res.;4+/-2°CY No <br /> 3.. <br /> if Circled, co>I>rt� ; . . <br /> * Prosect Mafiager and attach record of resolution. <br /> Gamola Rpcplot Loa <br />